Lash Consent Form

Full Name

Date of Birth

Address

Phone Number

Email Address

example@example.com

How did you hear about me

Emergency Contact Name

Emergency Contact Phone Number

Please enter a valid phone number.

What service are you requesting?

Lash lift onlyLash lift with tint

Have you ever gotten a lash lift or lash extensions?

YesNo

If yes, when was the last time you had a lash lift or lash extensions? Please specify which kind.

Leave blank if you’ve never gotten your lashes done.

Is there anything that youd like to share about your past experience?

Leave blank if you’ve never gotten your lashes done.

Have you had any previous reactions to eye treatments, including lash extensions or perms?

If yes, please describe

Do you have any eye conditions or infections?

YesNo

If yes, please specify.

Do you have irritated, itchy, or watery eyes?

YesNo

Do you wear contact lenses? (If yes, please be sure to come to your appointment without contact lenses or remove them prior to beginning the procedure.)

YesNo

Do you wear glasses?

YesNo

Please list any allergies or conditions I should know about. (This is extremely important as I need to make sure the products I use will not give you a reaction.)

Please list any food allergies, as some ingredients in the products may be derived from food sources such as nuts, aloe Vera, and oils.

Do you have any of the following conditions? (Please check all that apply.)

Are you currently taking any medication?

YesNo

If yes, please specify.

Are you currently pregnant or breastfeeding?

YesNo

Risks and Complications

While a lash lift is generally considered safe for most people, as with any cosmetic procedure, there are potential risks and complications:

Irritation and redness: the chemicals used in the lash lift process can cause eye irritation, redness, and discomfort, particularly if the solution contacts the skin or eye itself
Allergic reaction: some clients may experience an allergic reaction to the perming solution, glue, or other products used during the procedure. Symptoms can include severe swelling, itching, and irritation
Overprocessing: if the perming solution is left on the lashes too long, it can lead to overprocessed lashes that become brittle, dry, or overly curled.
Underprocessing: Conversely, if the perming solution is not left long enough, results might be less noticeable and not meet expectations.
Damage to Natural Lashes: There is a risk of temporary or permanent damage to natural lashes, including breakage or loss, especially if the lashes are weak or the procedure is not performed correctly.

Informed Consent:

Understanding the Procedure: I have been informed about the steps involved in a lash lift, including the application of chemical solutions and the use of silicone rods or pads to shape the lashes. I understand that the procedure is designed to enhance the appearance of my natural lashes by adding curl and definition.
Expected Results: I acknowledge that results vary per individual based on natural lash thickness, length, and lifecycle. The typical duration of lash lift effects is 6-8 weeks, but this can vary. I understand the final result may depend on the healthy of my natural lashes, and I am aware that no guarantee can be made regarding the specific outcome of the procedure.

Acknowledgment of Risks:

Common Side Effects: I am aware that typical side effects include temporary eye irritation, redness, and itching. These symptoms usually resolve shortly after the procedure.
Serious Rispects: While rare, more significant risks include allergic reactions, eye pain, vision mpairment, and damage to the natural lashes, such as breakage or loss. I understand these risks and agree that the lash technician is not liable for complications arising from disclosed conditions not adhering to aftercare instructions.

Aftercare Agreement:

l agree to follow all aftercare instructions provided by the lash technician, including keeping lashes dry for the first 24 hours, avoiding mascara for a specific period, and not using oil-based products around the eyes, which can affect the longevity of the lash lift.

Voluntary Participation:

I confirm that I am choosing to undergo this lash lift procedure voluntarily and have had the opportunity to ask questions about the treatment. I feel that all my questions have beer satisfactorily answered.

I hereby expressly waive and release any and all claims, now known or hereafter against Edessa Studio (the "business") and its successors, and assigns (collectively, "Released") on account of personal or psychological injury, illness, pain, suffering, temporary or permanent disabilities, allergic reactions, undesirable results, death, property damage, or financial loss arising out of or attributable to my being on the premises and receiving certain spa and/or beauty services, whether arising out of the ordinary negligence of the business or any Releasees or otherwise. I understand that I will not be serviced unless I sign. By signing this form, I confirm that I have read, understood, and agreed to all terms in this form, and I give my informed consent to proceed with the lash lift and/or tint services.

Signature

Date

Lash Lift and Tint Client Consent Form